Provider Demographics
NPI:1770921389
Name:VITALE, AMY CHRISTINE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:VITALE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:CIARAMITARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:14145 SIMONE DR.
Mailing Address - Street 2:DEVELOPING CONNECTIONS INC
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-566-6280
Mailing Address - Fax:586-566-1898
Practice Address - Street 1:14145 SIMONE DR.
Practice Address - Street 2:DEVELOPING CONNECTIONS INC
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-566-6280
Practice Address - Fax:586-566-1898
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14045928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist